ARKANSAS STATE UNIVERSITY
DEPARTMENT OF SOCIAL WORK
GRADUATE ADMISSIONS
P.O. Box 60, State University (Jonesboro), AR 72467
www.astate.edu
Phone: (870) 972-3029
Fax: (870) 972-3857
APPLICATION FOR ADMISSION TO THE MASTER OF SOCIAL WORK PROGRAM
Before indicating preferences, be sure you meet the requirements for your preferred degree program.
(If you mark more than one box, indicate order of preference, i.e. 1, 2, 3)
Application for:
Standard Master of Social Work Program (Full-time -- 2 Year Program)
Standard Master of Social Work Program (Part-time -- 4 Year Program)
Advanced Standing Master of Social Work Program (Full-time -- 1 Year Program)
Advanced Standing Master of Social Work Program (Part-time -- 2 Year Program)
Legal Name:
I.D. Number:
Last
Sex:
F
First
Middle
M Email Address:
Phone
Ethnicity/Race (optional):
DOB (Optional)
Permanent Address:
Mailing Address (If different):
Prerequisites completed with a grade of “C” or higher prior to applying.
Introduction to American Government
Human Biology
Introduction to Sociology
Social Statistical Methods & Lab or Quantitative Methods & Lab
Introduction to Psychology
Introduction to Social Work
Date your undergraduate degree was awarded
Have you taken a Web or Web-Assisted course? Yes
Major
No
Please check this box if you are interested in receiving information about the Addictions Certificate offered through the MSW program at ASU.
Arkansas State University educates leaders,
enhances intellectual growth and enriches lives.
Page 1
Send all forms to: Graduate Admissions Office – P. O. Box 60 – State University, AR 72467; gradsch@astate.edu
9/24/12
ARKANSAS STATE UNIVERSITY
DEPARTMENT OF SOCIAL WORK
GRADUATE ADMISSIONS
P.O. Box 60, State University (Jonesboro), AR 72467
www.astate.edu
Phone: (870) 972-3029
Fax: (870) 972-3857
Background checks and Compliance with ASU-Alcohol & Drug Policy:
I. Notice to all applicants re: Section 17-103-307 Criminal background checks (Selected parts).
(f) On and after October 1, 1997, each first-time applicant for a license issued by the Arkansas
Social Work Licensing Board shall be required to apply to the identification Bureau of the
Department of Arkansas State Police for a state and national criminal background check, to be
conducted by the Federal Bureau of Investigation.
(g) No person shall be eligible to receive or hold a license issued by the board if that person has
pleaded guilty or nolo contendere to, or been found guilty of any of the following offenses by any
court in the State of Arkansas, or of any similar offense by a court in another state, or of any
similar offense by a federal court. (The Social Work Licensing Act and the Regulations for the
Administration of the Social Work Licensing Act, 2001, 17-103-307
http://www.state.ar.us/swlb/licensing_info.html).
Please review the list of offenses using the web address above to determine if you will qualify for a social
work license in the State of Arkansas. Even though you may be admitted to the social work program and
successfully complete a social work degree from Arkansas State University, you may not qualify for
licensure in this state and/or in any other state.
II. ASU Alcohol and Drug Policy.
(h) Each student admitted in the MSW program must sign the compliance form for ASU Alcohol
and Drug Policy. Refer to Substance Abuse Policy and Procedures, College of Nursing and
Health Professions included in student handbook.
Signature:____________________________________________________ Date: _______________________________
Send all forms to: Graduate Admissions Office – P. O. Box 60 – State University, AR 72467; gradsch@astate.edu
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9/24/12
The Department of Social Work focuses on micro practice with individuals, mezzo practice with families and groups, and macro practice with
organizations and communities (DSW=m3) .
ARKANSAS STATE UNIVERSITY
DEPARTMENT OF SOCIAL WORK
GRADUATE ADMISSIONS
P.O. Box 60, State University (Jonesboro), AR 72467
www.astate.edu
Phone: (870) 972-3029
Fax: (870) 972-3857
PERSONAL AND PROFESSIONAL SOCIAL WORK GOALS
Please write a short paper on your personal and professional social work goals. Utilize The Publication
Manual of APA to construct your cover page, content, and reference page including professional citations. In
evaluating your writing, the admissions committee will consider the organization of your response, evidence
of critical thinking and analysis, that your choice of social work is based upon your own unique skills and
life challenges, any current social issues facing our world, and your understanding of social work values and
ethics.
This paper is limited to five pages maximum (not including cover and reference page).
1. Please discuss your understanding of the profession of social work, your reasons for choosing the
profession of social work, influences on your choice, and your future career goals (support your
reasoning with citations from the literature).
2. Describe employment and or volunteer experiences in which you exhibited leadership and/or
responsibility. How have these experiences readied you for graduate social work education?
3. Describe a situation in which you encountered an ethical issue and utilized social work values and
ethics to resolve the issue.
4. Explain your understanding of what is expected of you in pursing an MSW at Arkansas State
University.
Please identify any special circumstances, if applicable, that have affected your academic history that you
think the Admissions Committee needs to consider in making its decision.
Send all forms to: Graduate Admissions Office – P. O. Box 60 – State University, AR 72467; gradsch@astate.edu
9/24/12
DEPARTMENT OF SOCIAL WORK
GRADUATE ADMISSIONS
P.O. Box 60, State University (Jonesboro), AR 72467
www.astate.edu
Phone: (870) 972-3029
Fax: (870) 972-3857
APPLICANT REFERENCE
Applicant’s Name:
TO THE APPLICANT: Please print or type your reference’s name:
Please submit three letters of reference from people who are in a position to provide statements concerning your academic
qualifications or your recent or current employment (supervisors, employers, faculty or co-workers).
I understand that this reference is to be sent directly to the Graduate Admissions Office by the person writing the reference, and that I agree to:
Waive access to this reference
TO THE REFERENCE: The above named person is applying for admission to the Department of Social Work at Arkansas State
University. The candidate has given your name as a person having knowledge of his or her potential for undertaking graduate
study in social work. Please be candid in your assessment of the candidate. If unable to observe the applicant in a specific skill set,
please note it below. You may attach a separate letter to this form, if you like. Please send this reference form to the Graduate
School by mail, fax or email (P.O. Box 60 – State University, AR 72467; (870)972-3857; gradsch@astate.edu).
Since the School’s decision cannot be made until references have been received, we would appreciate a reply at your earliest convenience.
Thank you for your cooperation and interest.
1.
How long have you known the applicant?
2.
3.
In what capacity have you known the applicant? Supervisor
Co-Worker
Faculty
Please evaluate the applicant as fairly as you can in each of the following categories:
Not Observed/
Not Applicable
Below Average
(Bottom 50%)
Average
(Top 50%)
Good
(Top 25%)
Other
Superior
(Top 10%)
Exceptional
(Top 5%)
Academic performance
Intellectual ability
Judgment
Potential for contribution to
the profession
Emotional Maturity
Verbal skills
Written skills
Ability to think critically
Warmth
Ethics
Empathy
Genuineness
Capacity for leadership
Ability to work with
diverse persons
4.
5.
Please feel free to attach a separate letter providing additional information including any areas of concern.
I would: Recommend with enthusiasm
Recommend
Recommend with reservation. If so, please explain.
Do not recommend
Name:
Organization:
Title:
Phone:
Address:
Signature:______________________________________________________ Date: _________________________________
Send all forms to: Graduate Admissions Office – P. O. Box 60 – State University, AR 72467; gradsch@astate.edu
9/24/12